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Missouri rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,137.96 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $4,570.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $11,220.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $2,951.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $2,511.89 / $7,079.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $16,982.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,511.89 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,584.89 / $2,238.72